Our last blog outlined the neglect of Fecal Sludge Management (FSM) and presented new tools for diagnosing FSM challenges and pointing the way to solutions.
In this blog, we’ll share some lessons learned from the city-specific case studies and analysis to highlight key areas which need to be addressed if the non-networked sanitation services on which so many citizens rely are to be effectively managed.

Small towns* typically have not been well served by national or regional water utilities. Decentralization has become increasingly widely adopted, but even if local governments at the small town level have the power to operate a water utility, they often lack the capital and skills to do so. In response, some local governments and public institutions concentrate improvements on upgrading public utilities’ operations or strengthening community based management. In other cases, they choose to bring in the private sector knowledge of how to get clean water and sanitation services to more people more efficiently, affordably or sustainably. There is no one solution to addressing often very complex water and sanitation challenges.

There are many ways in which the public sector can leverage its own resources through partnering with the private sector. For the domestic private sector to fully realize its potential at scale in the small town sub-sector, we found they need capable and enabled public institutions to structure the market and regulate private operators.

Almost 600 million Indians living in rural areas defecate in the open. To meet the ambitious targets of the Indian government’s Swachh Bharat Mission Grameen (SBM (G)) – the rural clean India mission – plans to eliminate open defecation by 2019. SBM (G) is time-bound with a stronger results orientation, targeting the monitoring of both outputs (access to sanitation) and outcomes (usage). There is also a stronger focus on behavior change interventions and states have been accorded greater flexibility to adopt their own delivery mechanisms.

Open defecation remains a critical global health challenge, affecting almost 1 billion people around the world and contributing significantly to the estimated 842,000 people who die each year because of poor sanitation, hygiene practices, and unsafe water supplies [1].

Most behavior change approaches and frameworks for addressing open defecation have focused on relatively conscious, “reflective” drivers of behavior, including people’s emotions (such as pride or shame), rational knowledge (e.g., of germ theory), social norms, and explicit action plans (such as commitments to change). Using the framework popularized by renowned social psychologist Daniel Kahneman [2].<, these factors can be described as “System 2” drivers of behavior i.e., relatively conscious and motivational factors. It is now well established, however, that human behavior can also be heavily influenced by “System 1” drivers i.e., relatively automatic, cue-driven factors [3].

The study found that globally current levels of financing are likely to cover the capital costs of achieving universal basic WASH by 2030. The global capital costs amount to $28.4 billion per year (range: $13.8 to $46.7 billion). However, despite this good news, the current allocations need to be redirected and there will need to be significantly greater spending on sanitation (accounting for 69% of the cost of basic universal WASH) and operations and maintenance, as well as in the most off-track countries which are mainly in sub-Saharan Africa and South Asia.

A new study was recently carried out by the Water Global Practice’s Water and Sanitation Program on how to unlock the potential of Information and Communications Technology (ICT) to improve Water and Sanitation Services in Africa. The study suggests that promoting public participation and creating a system of transparency and accountability is critical to improve water and sanitation services to the poor [1] – as identified in earlier studies on the characteristics of well-performing public water utilities. The experiences and lessons learned from the study indicate the following six key ways on how to support the design and implementation of ICT tools to strengthen consumer voice and citizen engagement in the water and sanitation sector.

In December 2013, I was excited to receive funding through an Innovation Challenge Award to pilot water flow sensors in rural Tanzania, where the sustainability of rural water supply is a major development challenge. Approximately 38% of rural water points are not functioning properly. The sensor we wanted to develop would remotely monitor flow, making it easier to deliver operational information to the Ministry of Water’s water point mapping system.

The pilot brought one of the first 3D printers to Tanzania and we connected the American start-up WellDone International to the local non-governmental organization (NGO) Msabi. The project team implemented the gadget effectively, and my colleagues at the Water and Sanitation Program (WSP) and I navigated the procurement and implementation challenges. The pilot ended successfully in June of 2014 and we were proud of our achievement in bringing an innovative ICT solution to the Tanzanian rural water sector.

Back in 2009, Ratih Purwindah, a 25-year-old newly appointed sanitation district facilitator, was not invited to sit in the car to travel with delegates from Indonesia’s Ngawi District to participate in the East Java province rural sanitation review meeting. Instead, Ratih was asked to take a bus the 180 km to Surabaya, even though there were vacant seats in the delegation’s car. She also did not get a desk at the district’s office. Five years onwards, this has changed and Ratih is now the provincial coordinator for the government’s sanitation program in Central Java. District sanitation facilitators working with her are recognized and empowered within District Health offices. Ratih’s personal journey is a testament to the systemic changes that have taken place in Indonesia. With a focus on district-wide sanitation service delivery, Indonesia is accelerating access from below 1% to 2-3% a year and catching up to achieve the sanitation MDG.

When we go to the supermarket, our decision-making is considerably aided by having the price, ingredients and source of goods clearly labeled. This allows us to rapidly compare the characteristics, perceived benefits, and price of different products to make what is usually an informed and instantaneous purchase decision.

When it comes to making investment choices for public programs, we do not traditionally have the same luxury of information. The full benefits and costs of those interventions, including the long-term costs to maintain and operate a service, are rarely understood or taken into account in the decision. As a result, public decisions are usually made based on the most visible costs (capital investment required from the public budget), historical choices and the political process.